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Pain Treatment

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Bottom Line Recommendations English (5) French (1) All (6)

Bottom Line Recommendations: Pain Treatment

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Ali, S, Drendel A and TREKK Network

Bottom line recommendations for pediatric pain treatment. Published online: May 2018.

Bottom Line Recommenation: Optimal pain relief for pediatric MSK injury.

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Korownyk C, Young J, Michael Allan G

Evidence suggests that ibuprofen provides better single-agent relief than acetaminophen or codeine, and is at least equivalent to both acetaminophen with codeine and morphine for acute injury pain, with fewer adverse events.

Dosing Chart: Analgesic starting dosages for children

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World Health Organization

Analgesic starting doses for children.

Chart: WHO pain wall chart for waiting rooms

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World Health Organization

Is your child in pain? The doctor can help. As for pain treatment!

Measurement Tool: Faces Pain Scale - Revised for children 4 years of age and older

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International Association for the Study of Pain

Scores are from the left to the right (for the child): 0, 2, 4, 6, 8, 10 (0 for no pain at all and 10 for very, very much in pain).

Recommandations de Base: Prise en charge de la douleur

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Ali, S, Drendel A and TREKK Network

Recommandations de base pour la prise en charge de la douleur aigüe chez l’enfant. Publiée en ligne juillet 2018.

 

Bottom Line Recommendations: Pain Treatment

Download

Ali, S, Drendel A and TREKK Network

Bottom line recommendations for pediatric pain treatment. Published online: May 2018.

Recommandations de Base: Prise en charge de la douleur

Download

Ali, S, Drendel A and TREKK Network

Recommandations de base pour la prise en charge de la douleur aigüe chez l’enfant. Publiée en ligne juillet 2018.

 

Bottom Line Recommenation: Optimal pain relief for pediatric MSK injury.

Visit

Korownyk C, Young J, Michael Allan G

Evidence suggests that ibuprofen provides better single-agent relief than acetaminophen or codeine, and is at least equivalent to both acetaminophen with codeine and morphine for acute injury pain, with fewer adverse events.

Dosing Chart: Analgesic starting dosages for children

Visit

World Health Organization

Analgesic starting doses for children.

Chart: WHO pain wall chart for waiting rooms

Visit

World Health Organization

Is your child in pain? The doctor can help. As for pain treatment!

Measurement Tool: Faces Pain Scale - Revised for children 4 years of age and older

Visit

International Association for the Study of Pain

Scores are from the left to the right (for the child): 0, 2, 4, 6, 8, 10 (0 for no pain at all and 10 for very, very much in pain).

Clinical guidelines English (7) French All (7)

Clinical Practice Guideline: Effective Management of Pain and Anxiety for the Pediatric Patient in the Emergency Department.

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Young VB

A summary of what to expect with pediatric patients experiencing pain and anxiety.

Clinical Practice Guideline: Management of acute pediatric pain in the emergency department.

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Ruest S,Anderson A.

This article provides a summary of recommendations for the multimodal and multidisciplinary approach to acute pediatric pain management and highlights recent research on this topic.

Clinical Practice Guideline: Codeine:Time to Say "No".

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American Academy of Pediatrics

Suggests not using codeine for pediatric patients for pain management

Clinical Practice Guideline: Relief of pain and anxiety in pediatric patients in emergency medical systems

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Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine an...

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a childs and familys reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.

Clincial Practice Guideline: Optimizing the treatment of pain in patients with acute presentations

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American Society for Pain Management Nursing (ASPMN), Emergency Nurses Associ...

Management of pain is an essential nursing and physician responsibility. This joint position statement describes recommendations for improving pain management in health care settings.

Clincial Practice Guideline: The recognition and assessment of acute pain in children

Visit

Royal College of Nursing

The Royal College of Nursing (RCN) has previously produced a guideline on the Assessment of acute pain in children (2000). This guideline examined when pain in children should be assessed and by whom, and the use of scales and other tools that can be used to facilitate the assessment of childrens pain.

Clinical Practice Guideline: The assessment and management of acute pain in infants, children, and adolescents

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American Academy of Pediatrics

Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, pediatricians need to expand their knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly, use a multimodal approach to pain management, use a multidisciplinary approach when possible, involve families, and advocate for the use of effective pain management in children.

Clinical Practice Guideline: Effective Management of Pain and Anxiety for the Pediatric Patient in the Emergency Department.

Visit

Young VB

A summary of what to expect with pediatric patients experiencing pain and anxiety.

Clinical Practice Guideline: Management of acute pediatric pain in the emergency department.

Visit

Ruest S,Anderson A.

This article provides a summary of recommendations for the multimodal and multidisciplinary approach to acute pediatric pain management and highlights recent research on this topic.

Clinical Practice Guideline: Codeine:Time to Say "No".

Visit

American Academy of Pediatrics

Suggests not using codeine for pediatric patients for pain management

Clinical Practice Guideline: Relief of pain and anxiety in pediatric patients in emergency medical systems

Visit

Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine an...

Control of pain and stress for children is a vital component of emergency medical care. Timely administration of analgesia affects the entire emergency medical experience and can have a lasting effect on a childs and familys reaction to current and future medical care. A systematic approach to pain management and anxiolysis, including staff education and protocol development, can provide comfort to children in the emergency setting and improve staff and family satisfaction.

Clincial Practice Guideline: Optimizing the treatment of pain in patients with acute presentations

Visit

American Society for Pain Management Nursing (ASPMN), Emergency Nurses Associ...

Management of pain is an essential nursing and physician responsibility. This joint position statement describes recommendations for improving pain management in health care settings.

Clincial Practice Guideline: The recognition and assessment of acute pain in children

Visit

Royal College of Nursing

The Royal College of Nursing (RCN) has previously produced a guideline on the Assessment of acute pain in children (2000). This guideline examined when pain in children should be assessed and by whom, and the use of scales and other tools that can be used to facilitate the assessment of childrens pain.

Clinical Practice Guideline: The assessment and management of acute pain in infants, children, and adolescents

Visit

American Academy of Pediatrics

Pediatricians are responsible for eliminating or assuaging pain and suffering in children when possible. To accomplish this, pediatricians need to expand their knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly, use a multimodal approach to pain management, use a multidisciplinary approach when possible, involve families, and advocate for the use of effective pain management in children.

Summaries of systematic reviews English (3) French All (3)

Cochrane Summary: Intranasal fentanyl for the treatment of children in acute pain

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Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Background: Pain is the most common reason why patients are seen in emergency departments (EDs). The challenging nature of treating children in acute severe pain is reflected in the medical literature by poor pain management in this population. We reviewed evidence on the effect of intranasal fentanyl (INF) (a strong pain relief drug, similar to morphine) compared with any other pain-relieving technique for treatment of children in acute severe pain. Study characteristics: We included studies with children (younger than 18 years of age) suffering from acute severe pain as a result of injury or medical illness. The target intervention was INF administered for pain relief compared with any other drug intervention for pain relief (e.g. intravenous morphine) or non-drug intervention (e.g. limb splinting, wound dressing) provided in the emergency setting. The evidence is current to January 2014. Key results: We identified three studies that included 313 children with acute severe pain resulting from broken bones of the upper and lower limbs. These trials compared INF versus morphine administered by a needle into a muscle (intramuscular morphine) or via a drip into a vein (intravenous morphine), as well as standard concentration INF versus high concentration INF. The collective study population in these trials consisted of children three to 15 years of age. Males accounted for approximately two-thirds of the overall study population. The review concluded that INF may be an effective analgesic for the treatment of children in acute moderate to severe pain, and its administration appears to cause minimal distress to children; however, the evidence is insufficient to permit judgement of the effects of INF compared with intramuscular or intravenous morphine. No serious adverse events (e.g. opiate toxicity, death) were reported. Limitations: Limitations of this review include the following: Few studies (three) were eligible for inclusion; no study examined the use of INF in children younger than three years of age; no study included children with pain resulting from a "medical" cause (e.g. abdominal pain seen in appendicitis); and all eligible studies were conducted in Australia. Consequently, the findings may not be generalizable to other healthcare settings, to children younger than three years of age and to those with pain from a "medical" cause.

Cochrane Summary: Nerve blocks for initial pain management of thigh bone fractures in children

Visit

Black KJ, Bevan CA, Murphy NG, Howard JJ

Fractures (breaks) of the thigh bone can be very painful, particularly when a child arrives in a stressful emergency environment and is undergoing assessment. Moving the child to get X-rays or transferring the child to a special bed to support the leg in traction (keeping the leg straight) can cause additional pain, as can placing traction (a pulling force) on the broken thigh. This means that prompt provision of pain relief is an essential part of initial emergency management. This review investigated whether a nerve block, involving the injection of a freezing/numbing medication at the top of the thigh, would provide more effective pain relief than pain medicine given by mouth or into a vein (intravenously, e.g. morphine). We searched several medical databases and trial registries up to January 2013 and contacted researchers. We found one study that looked at the comparison we were interested in. This study was potentially biased, mainly because the care providers, parents and children were aware of the type of pain relief the children received. The study was small, involving 55 children aged 16 months to 15 years, and showed that the children who received one of the two main types of nerve block tended to have less pain after 30 minutes than those who received intravenous morphine for initial pain control. The nerve blocks led to some pain and redness at the injection site in a few cases, while intravenous morphine caused more serious problems such as depressed breathing (lack of oxygen), excessive sleepiness and vomiting in a small number of children. Moreover, children who had nerve blocks continued to have lower pain scores over a six-hour period with less need for additional pain relief. There was insufficient evidence to determine whether children or parents were more satisfied with one method of pain relief than the other. Use of resources (e.g. nursing time, cost of medications) was not measured. The quality of the study included in this review was low and so these conclusions are not certain. Further well designed studies investigating whether nerve blocks are more effective and safer than other means of pain relief are needed.

Cochrane Summary: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Antibiotics make little difference to children with an uncomplicated ear infection and ear pain. Some advocate ear drops with local anaesthetic such as amethocaine, benzocaine or lidocaine. Five trials (391 participants) were identified; two compared anaesthetic drops to placebo (inactive) drops; and three compared anaesthetic drops to herbal ear drops. There was no strong evidence that herbal ear drops were effective, but anaesthetic drops did provide better pain relief than the inactive drops. Only one trial looked at adverse reactions and reported no cases of ringing in the ears or unsteadiness when walking and three cases of very mild dizziness. Children in all the trials experienced a rapid, short-term reduction in pain after using ear drops. It is hard to know if this was the result of the natural course of the illness; the placebo effect of receiving treatment; the soothing effect of any liquid in the ear or the pharmacological effects of the ear drops themselves. Nevertheless, there is some evidence that when combined with oral pain medication, anaesthetic ear drops may help to relieve pain more rapidly in children aged three to 18 years. More good-quality trials are needed.

Cochrane Summary: Intranasal fentanyl for the treatment of children in acute pain

Visit

Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Background: Pain is the most common reason why patients are seen in emergency departments (EDs). The challenging nature of treating children in acute severe pain is reflected in the medical literature by poor pain management in this population. We reviewed evidence on the effect of intranasal fentanyl (INF) (a strong pain relief drug, similar to morphine) compared with any other pain-relieving technique for treatment of children in acute severe pain. Study characteristics: We included studies with children (younger than 18 years of age) suffering from acute severe pain as a result of injury or medical illness. The target intervention was INF administered for pain relief compared with any other drug intervention for pain relief (e.g. intravenous morphine) or non-drug intervention (e.g. limb splinting, wound dressing) provided in the emergency setting. The evidence is current to January 2014. Key results: We identified three studies that included 313 children with acute severe pain resulting from broken bones of the upper and lower limbs. These trials compared INF versus morphine administered by a needle into a muscle (intramuscular morphine) or via a drip into a vein (intravenous morphine), as well as standard concentration INF versus high concentration INF. The collective study population in these trials consisted of children three to 15 years of age. Males accounted for approximately two-thirds of the overall study population. The review concluded that INF may be an effective analgesic for the treatment of children in acute moderate to severe pain, and its administration appears to cause minimal distress to children; however, the evidence is insufficient to permit judgement of the effects of INF compared with intramuscular or intravenous morphine. No serious adverse events (e.g. opiate toxicity, death) were reported. Limitations: Limitations of this review include the following: Few studies (three) were eligible for inclusion; no study examined the use of INF in children younger than three years of age; no study included children with pain resulting from a "medical" cause (e.g. abdominal pain seen in appendicitis); and all eligible studies were conducted in Australia. Consequently, the findings may not be generalizable to other healthcare settings, to children younger than three years of age and to those with pain from a "medical" cause.

Cochrane Summary: Nerve blocks for initial pain management of thigh bone fractures in children

Visit

Black KJ, Bevan CA, Murphy NG, Howard JJ

Fractures (breaks) of the thigh bone can be very painful, particularly when a child arrives in a stressful emergency environment and is undergoing assessment. Moving the child to get X-rays or transferring the child to a special bed to support the leg in traction (keeping the leg straight) can cause additional pain, as can placing traction (a pulling force) on the broken thigh. This means that prompt provision of pain relief is an essential part of initial emergency management. This review investigated whether a nerve block, involving the injection of a freezing/numbing medication at the top of the thigh, would provide more effective pain relief than pain medicine given by mouth or into a vein (intravenously, e.g. morphine). We searched several medical databases and trial registries up to January 2013 and contacted researchers. We found one study that looked at the comparison we were interested in. This study was potentially biased, mainly because the care providers, parents and children were aware of the type of pain relief the children received. The study was small, involving 55 children aged 16 months to 15 years, and showed that the children who received one of the two main types of nerve block tended to have less pain after 30 minutes than those who received intravenous morphine for initial pain control. The nerve blocks led to some pain and redness at the injection site in a few cases, while intravenous morphine caused more serious problems such as depressed breathing (lack of oxygen), excessive sleepiness and vomiting in a small number of children. Moreover, children who had nerve blocks continued to have lower pain scores over a six-hour period with less need for additional pain relief. There was insufficient evidence to determine whether children or parents were more satisfied with one method of pain relief than the other. Use of resources (e.g. nursing time, cost of medications) was not measured. The quality of the study included in this review was low and so these conclusions are not certain. Further well designed studies investigating whether nerve blocks are more effective and safer than other means of pain relief are needed.

Cochrane Summary: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Antibiotics make little difference to children with an uncomplicated ear infection and ear pain. Some advocate ear drops with local anaesthetic such as amethocaine, benzocaine or lidocaine. Five trials (391 participants) were identified; two compared anaesthetic drops to placebo (inactive) drops; and three compared anaesthetic drops to herbal ear drops. There was no strong evidence that herbal ear drops were effective, but anaesthetic drops did provide better pain relief than the inactive drops. Only one trial looked at adverse reactions and reported no cases of ringing in the ears or unsteadiness when walking and three cases of very mild dizziness. Children in all the trials experienced a rapid, short-term reduction in pain after using ear drops. It is hard to know if this was the result of the natural course of the illness; the placebo effect of receiving treatment; the soothing effect of any liquid in the ear or the pharmacological effects of the ear drops themselves. Nevertheless, there is some evidence that when combined with oral pain medication, anaesthetic ear drops may help to relieve pain more rapidly in children aged three to 18 years. More good-quality trials are needed.

Systematic reviews English (17) French All (17)

Systematic Review: Drugs for the acute treatment of migraine in children and adolescents.

Visit

Faber AJ,Lagman-Bartolome AM,Rajapakse T

To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 1217 years of age.

Systematic Review: Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: A systematic review

Visit

Castarlenas E, Jensen MP, von Baeyer CL, Mir J.

Objective: The Numerical Rating Scale-11 (NRS-11) is one of the most widely used scales to assess self-reported pain intensity in children, despite the limited information on its psychometric properties for assessing pain in pediatric populations. Recently, there has been an increase in published findings regarding the strengths and weaknesses of the NRS-11 as a measure of pain in youths. The purpose of this study was to review this research and summarize what is known regarding the reliability and validity of the NRS-11 as a self-report measure of pediatric pain intensity.

Systematic Review: Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review.

Visit

Le May S,Ali S,Khadra C,Drendel AL,Trottier ED,Gouin S,Poonai N.

Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries.

Systematic Review: How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review.

Visit

Hartling L, Ali S, Dryden DM, Chordiya P, Johnson DW, Plint AC, Stang A, McGr...

We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years) treated in ambulatory settings

Cochrane Systematic Review: Intranasal fentanyl for the management of acute pain in children

Visit

Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Objective: We identified and evaluated all randomized controlled trials (RCTs) and quasi-randomized trials to assess the effects of intranasal fentanyl (INF) versus alternative analgesic interventions in children with acute pain, with respect to reduction in pain score, occurrence of adverse events, patient tolerability, use of "rescue analgesia," patient/parental satisfaction and patient mortality.

Systematic Review: Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis

Visit

Poonai N, Paskar D, Konrad SL, Rieder M, Joubert G, Lim R, Golozar A, Uledi S...

Objectives: There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications.

Cochrane Systematic Review: Nerve blocks for initial pain management of femoral fractures in children

Visit

Black KJ, Bevan CA, Murphy NG, Howard JJ

Objectives: To assess the effects (benefits and harms) of femoral nerve block (FNB) or fascia iliaca compartment block (FICB) for initial pain management of children with fractures of the femur (thigh bone) in the pre-hospital or in-hospital emergency setting, with or without systemic analgesia.

Review: Treating abdominal pain in children: what do we know?

Visit

Ali S, Sli H

Abdominal pain is a common reason for emergency department visits in the United States. Failure to treat children's pain has long been considered substandard and unethical. Within the emergency department setting, pain has been repeatedly shown to be undertreated. Analgesic medications are suboptimally used for children with abdominal pain because of a wide variety of causes. To our knowledge, there is no standard of care for the treatment of such pain. As such, several recent studies have set out to determine the most appropriate methods to address this gap in knowledge. The proceeding article will attempt to review the literature as it pertains to severe acute abdominal pain, biliary colic, renal colic, and dysmenorrhea.

Systematic Review: A systematic review of faces scales for the self-report of pain intensity in children

Visit

Tomlinson D, von Baeyer CL, Stinson JN, Sung L

Objectives: To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility.

Systematic Review: Pain management and sedation for children in the emergency department

Visit

Atkinson P, Chesters A, Heinz P

We provide an overview of published evidence to help clinicians assess, manage, and minimise pain in children presenting to hospital.

Systematic Review: Treatment of children with migraine in the emergency department: a qualitative systematic review

Visit

Bailey B, McManus BC

Objective: To evaluate which treatment could be effective in the emergency department (ED) for children with migraine and status migrainosus, we carried out a qualitative systematic review of randomized controlled trials (RCTs) that evaluated treatment that could be used for those conditions.

Review: Does analgesia mask diagnosis of appendicitis among children?

Visit

Bromberg R, Goldman RD

Question: Can analgesia be given safely to patients with suspected appendicitis prior to surgical evaluation without masking physical signs and symptoms?

Systematic Review: Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties.

Visit

Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN

Objectives: Our aim was to review the measurement properties of single-item self-report pain intensity measures in children 3 to 18 years old. A secondary aim was to develop evidence-based recommendations for measurement of child and adolescent self-report of acute, postoperative, and chronic pain.

Cochrane Systematic Review: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Objectives: To assess the effectiveness of topical analgesia for AOM.

Review: Pediatric pain management in the emergency department

Visit

Bauman BH, McManus JG

In this article, the authors review the history of ED pediatric pain management and sedation, discuss special considerations in pediatric pain assessment and management, review various pharmacologic and nonpharmacologic methods of alleviating pain and anxiety, and present ideas to improve the culture of the pediatric ED, so that it can achieve the goal of becoming pain-free.

Sytematic Review: Symptomatic treatment of migraine in children: a systematic review of medication trials

Visit

Damen L, Bruijn JK, Verhagen AP, Berger MY, Passchier J, Koes BW

Objective: Treatment of pediatric migraine includes an individually tailored regimen of both nonpharmacologic and pharmacologic measures. The mainstay of symptomatic treatment in children with migraine is intermittent oral or suppository analgesics, but there is no coherent body of evidence on symptomatic treatment of childhood migraine available. The objective of this review is to describe and assess the evidence from randomized and clinical controlled trials concerning the efficacy and tolerability of symptomatic treatment of migraine in children.

Review: Analgesics for the treatment of pain in children

Visit

Berde CB, Sethna NF

Studies over the past 15 years suggest that neonates, infants, and children can receive analgesia and anesthesia safely, with proper age-related adjustments in clinical practice and dosing. Although the emphasis in this review is on the pharmacologic management of pain, several nonpharmacologic approaches, including hypnosis and related cognitive behavioral approaches, have had good efficacy in children with acute or chronic pain.5,6 Making the hospital environment a less terrifying place may reduce anxiety and fear, which can themselves exacerbate pain.7 Conversely, nonpharmacologic approaches should not be used as an excuse to withhold appropriate analgesics.

Systematic Review: Drugs for the acute treatment of migraine in children and adolescents.

Visit

Faber AJ,Lagman-Bartolome AM,Rajapakse T

To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 1217 years of age.

Systematic Review: Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents: A systematic review

Visit

Castarlenas E, Jensen MP, von Baeyer CL, Mir J.

Objective: The Numerical Rating Scale-11 (NRS-11) is one of the most widely used scales to assess self-reported pain intensity in children, despite the limited information on its psychometric properties for assessing pain in pediatric populations. Recently, there has been an increase in published findings regarding the strengths and weaknesses of the NRS-11 as a measure of pain in youths. The purpose of this study was to review this research and summarize what is known regarding the reliability and validity of the NRS-11 as a self-report measure of pediatric pain intensity.

Systematic Review: Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review.

Visit

Le May S,Ali S,Khadra C,Drendel AL,Trottier ED,Gouin S,Poonai N.

Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries.

Systematic Review: How Safe Are Common Analgesics for the Treatment of Acute Pain for Children? A Systematic Review.

Visit

Hartling L, Ali S, Dryden DM, Chordiya P, Johnson DW, Plint AC, Stang A, McGr...

We examined evidence comparing the safety profiles of three groups of oral medications, acetaminophen, nonsteroidal anti-inflammatory drugs, and opioids, to manage acute nonsurgical pain in children (<18 years) treated in ambulatory settings

Cochrane Systematic Review: Intranasal fentanyl for the management of acute pain in children

Visit

Murphy A, O'Sullivan R, Wakai A, Grant TS, Barrett MJ, Cronin J, McCoy SC, Ho...

Objective: We identified and evaluated all randomized controlled trials (RCTs) and quasi-randomized trials to assess the effects of intranasal fentanyl (INF) versus alternative analgesic interventions in children with acute pain, with respect to reduction in pain score, occurrence of adverse events, patient tolerability, use of "rescue analgesia," patient/parental satisfaction and patient mortality.

Systematic Review: Opioid analgesia for acute abdominal pain in children: A systematic review and meta-analysis

Visit

Poonai N, Paskar D, Konrad SL, Rieder M, Joubert G, Lim R, Golozar A, Uledi S...

Objectives: There are long-held concerns that analgesia in patients with acute abdominal pain may obscure the physical examination and lead to missing a diagnosis of appendicitis. Despite evidence to the contrary, analgesia continues to be underutilized and suboptimally dosed in children with acute abdominal pain. The objective of this systematic review and meta-analysis was to determine if opioids provide analgesia without an increase in side effects and appendicitis-related complications.

Cochrane Systematic Review: Nerve blocks for initial pain management of femoral fractures in children

Visit

Black KJ, Bevan CA, Murphy NG, Howard JJ

Objectives: To assess the effects (benefits and harms) of femoral nerve block (FNB) or fascia iliaca compartment block (FICB) for initial pain management of children with fractures of the femur (thigh bone) in the pre-hospital or in-hospital emergency setting, with or without systemic analgesia.

Review: Treating abdominal pain in children: what do we know?

Visit

Ali S, Sli H

Abdominal pain is a common reason for emergency department visits in the United States. Failure to treat children's pain has long been considered substandard and unethical. Within the emergency department setting, pain has been repeatedly shown to be undertreated. Analgesic medications are suboptimally used for children with abdominal pain because of a wide variety of causes. To our knowledge, there is no standard of care for the treatment of such pain. As such, several recent studies have set out to determine the most appropriate methods to address this gap in knowledge. The proceeding article will attempt to review the literature as it pertains to severe acute abdominal pain, biliary colic, renal colic, and dysmenorrhea.

Systematic Review: A systematic review of faces scales for the self-report of pain intensity in children

Visit

Tomlinson D, von Baeyer CL, Stinson JN, Sung L

Objectives: To summarize and systematically review faces pain scales most commonly used to obtain self-report of pain intensity in children for evaluation of reliability and validity and to compare the scales for preference and utility.

Systematic Review: Pain management and sedation for children in the emergency department

Visit

Atkinson P, Chesters A, Heinz P

We provide an overview of published evidence to help clinicians assess, manage, and minimise pain in children presenting to hospital.

Systematic Review: Treatment of children with migraine in the emergency department: a qualitative systematic review

Visit

Bailey B, McManus BC

Objective: To evaluate which treatment could be effective in the emergency department (ED) for children with migraine and status migrainosus, we carried out a qualitative systematic review of randomized controlled trials (RCTs) that evaluated treatment that could be used for those conditions.

Review: Does analgesia mask diagnosis of appendicitis among children?

Visit

Bromberg R, Goldman RD

Question: Can analgesia be given safely to patients with suspected appendicitis prior to surgical evaluation without masking physical signs and symptoms?

Systematic Review: Recommendations for selection of self-report pain intensity measures in children and adolescents: a systematic review and quality assessment of measurement properties.

Visit

Birnie KA, Hundert AS, Lalloo C, Nguyen C, Stinson JN

Objectives: Our aim was to review the measurement properties of single-item self-report pain intensity measures in children 3 to 18 years old. A secondary aim was to develop evidence-based recommendations for measurement of child and adolescent self-report of acute, postoperative, and chronic pain.

Cochrane Systematic Review: Topical analgesia for acute otitis media

Visit

Foxlee R, Johansson A, Wejfalk J, Dawkins J, Dooley L, Del Mar C

Objectives: To assess the effectiveness of topical analgesia for AOM.

Review: Pediatric pain management in the emergency department

Visit

Bauman BH, McManus JG

In this article, the authors review the history of ED pediatric pain management and sedation, discuss special considerations in pediatric pain assessment and management, review various pharmacologic and nonpharmacologic methods of alleviating pain and anxiety, and present ideas to improve the culture of the pediatric ED, so that it can achieve the goal of becoming pain-free.

Sytematic Review: Symptomatic treatment of migraine in children: a systematic review of medication trials

Visit

Damen L, Bruijn JK, Verhagen AP, Berger MY, Passchier J, Koes BW

Objective: Treatment of pediatric migraine includes an individually tailored regimen of both nonpharmacologic and pharmacologic measures. The mainstay of symptomatic treatment in children with migraine is intermittent oral or suppository analgesics, but there is no coherent body of evidence on symptomatic treatment of childhood migraine available. The objective of this review is to describe and assess the evidence from randomized and clinical controlled trials concerning the efficacy and tolerability of symptomatic treatment of migraine in children.

Review: Analgesics for the treatment of pain in children

Visit

Berde CB, Sethna NF

Studies over the past 15 years suggest that neonates, infants, and children can receive analgesia and anesthesia safely, with proper age-related adjustments in clinical practice and dosing. Although the emphasis in this review is on the pharmacologic management of pain, several nonpharmacologic approaches, including hypnosis and related cognitive behavioral approaches, have had good efficacy in children with acute or chronic pain.5,6 Making the hospital environment a less terrifying place may reduce anxiety and fear, which can themselves exacerbate pain.7 Conversely, nonpharmacologic approaches should not be used as an excuse to withhold appropriate analgesics.

Key studies English (35) French All (35)

Key Study: Changes in Pain Score Associated With Clinically Meaningful Outcomes in Children With Acute Pain.

Visit

Tsze DS, Hirschfeld G, von Baeyer CL, Suarez LE, Dayan PS.

This was a crosssectional study of children 6 to 17 and 4 to 17 years old who were assessed using the Verbal Numerical Rating Scale (VNRS) and Faces Pain ScaleRevised (FPSR), respectively

Key Study: Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale.

Visit

Le May S, Ballard A, Khadra C, Gouin S, Plint AC, Villeneuve E, Msse B, Tsze ...

The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED)

Key Study: Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale-Revised and Color Analog Scale in Children With Acute Pain.

Visit

Tsze DS, Hirschfeld G, Dayan PS, Bulloch B, von Baeyer CL.

The aims of this study were to define theFacesPainScaleRevised(FPS-R) andColor Analog Scale(CAS) scores associated with nopain, mildpain, moderatepain, and severepainin children with acutepain, and to identify differences based on age, sex, and ethnicity.

Key Study: A comparison of pain assessment by physicians, parents and children in an outpatient setting

Visit

Christina Brudvik,Svein-Denis Moutte, Valborg Baste,andTone Morken

Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.

Key Study: Oral Analgesics Utilization for Children With Musculoskeletal Injury (OUCH Trial): An RCT

Visit

Le May S, Ali S, Plint AC, Msse B, Neto G, Auclair MC, Drendel AL, Ballard A,...

We aimed to test the efficacy of a combination of an anti-inflammatory drug with an opioid for pain management of MSK-I in children presenting to the ED.

Key Study: FactorsAssociatedWithDischargeAfterInitialEmergency TreatmentofPediatricMigraine.

Visit

Aravamuthan BR,Mar SS,Williams KG.

Migraine treatment varies widely in the pediatric emergency department (ED). Factors associated with discharge after only initial emergency treatment were examined.

Key Study: Efficacy and tolerability of zolmitriptan nasal spray for the treatment ofacutemigraine in adolescents: Results of a randomized, double-blind, multi-center, parallel-group study (TEENZ).

Visit

Winner P,Farkas V,tillov H,Woodruff B,Liss C,Lillieborg S,Raines S;TEENZ Stud...

The primary objective of the TEENZ Study (NCT01211145) was to assess the efficacy of zolmitriptan nasal spray in the acute treatment of adolescent migraine patients (ages 12 to 17 years), as measured by the primary outcome variable of pain-free status at 2 hours post-treatment.

Key Study: Drugs for the acute treatment of migraine in children and adolescents.

Visit

Richer L, Billinghurst L, Linsdell MA, Russell K, Vandermeer B, Crumley ET, D...

To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 12 to 17 years of age.

Key Study: Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Visit

Daoust R, Paquet J, Bailey B, Lavigne G, Piette E, Sanogo K, Chauny JM

Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain.

Key Study: Ultrasound-guided forearm nerve blocks in kids: a novel method forpaincontrol in the treatment of hand-injuredpediatricpatients in the emergency department.

Visit

Frenkel O,Liebmann O,Fischer JW.

Ultrasound-guided forearm nerve blocks have been shown to safely reduce pain for emergency procedures in the adult emergency department (ED). Although ultrasonography is widely used for forearm nerve blocks in the adult ED and in the pediatric operating room, no study to date has examined its use in the pediatric emergency setting.

Key Study: Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial

Visit

Poonai N, Bhullar G, Lin K, Papini A, Mainprize D, Howard J, Teefy J, Bale M,...

Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain.

Key Study: Association of race and ethnicity with management of abdominal pain in the emergency department

Visit

Johnson TJ, Weaver MD, Borrero S, Davis EM, Myaskovsky L, Zuckerbraun NS, Kra...

Objective: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs).

Key Study: Reliability of the visual analog scale in children with acute pain in the emergency department

Visit

Bailey B, Gravel J, Daoust R

In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10mm on a 100-mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8-17 years presenting to a pediatric emergency department with acute pain.

Key Study: Equivalency of two concentrations of fentanyl administered by the intranasal route for acute analgesia in children in a paediatric emergency department: a randomized controlled trial

Visit

Borland M, Milsom S, Esson A

Objective: Intranasal fentanyl's (INF) effectiveness is established using highly concentrated INF (HINF). Standard concentration INF (SINF) is more widely available. We aimed to illustrate the equivalence of SINF to HINF.

Key Study: Pain assessment for children: overcoming challenges and optimizing care

Visit

Drendel AL, Kelly BT, Ali S

This review will highlight the many complexities of the assessment of pain for the pediatric patient. In addition, a variety of factors that affect the self-report of pain in children will be identified.

Key Study: Pain management of musculoskeletal injuries in children: current state and future directions

Visit

Ali S, Drendel AL, Kircher J, Beno S

Objectives: Upon completion of this CME article, the reader should be better able to (1) distinguish multiple nonpharmacological techniques for minimizing and treating pain and anxiety in children with musculoskeletal injuries, (2) apply recent medical literature in deciding pharmacological strategies for the treatment of children with musculoskeletal injuries, and (3) interpret the basic principles of pharmacogenomics and how they relate to analgesic efficacy.

Key Study: Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain

Visit

Saunders M, Adelgais K, Nelson D

Objectives: The objective was to evaluate the use of a single 2 g/kg dose of intranasal fentanyl as analgesia for painful orthopedic injuries in children presenting to a pediatric emergency department (ED).

Key Study: Clinical outcomes of children treated with intravenous prochlorperazine for migraine in a pediatric emergency department

Visit

Trottier ED, Bailey B, Dauphin-Pierre S, Gravel J

Objective: To evaluate the rate of treatment failure associated with prochlorperazine used in children with severe migraine in a pediatric ED.

Key Study: A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain

Visit

Drendel AL, Gorelick MH, Weisman SJ, Lyon R, Brousseau DC, Kim MK

Study Objective: We compare the treatment of pain in children with arm fractures by ibuprofen 10 mg/kg versus acetaminophen with codeine 1 mg/kg/dose (codeine component).

Key Study: Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: a randomized clinical trial

Visit

Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR

Objectives: This study compared the analgesic effectiveness of acetaminophen-codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting.

Key Study: Comparative review of the clinical use of intranasal fentanyl versus morphine in a paediatric emergency department

Visit

Borland ML, Clark LJ, Esson A

Objectives: Comparison of intranasal fentanyl (INF) and parenteral morphine in children in an ED. Primary objective was to compare time to analgesia from presentation, with secondary objectives to assess patient profiles, specifics of opiate analgesics used plus rate of i.v. access for analgesia alone.

Key Study: Oxycodone versus codeine for triage pain in children with suspected forearm fracture: a randomized controlled trial

Visit

Charney RL, Yan Y, Schootman M, Kennedy RM, Luhmann JD

Objective: To compare the efficacy of pain reduction of triage oxycodone (O) versus codeine (C) to children with suspected forearm fractures.

Key Study: Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial

Visit

Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A

Study Objective: The evidence supporting the use of analgesia in children with abdominal pain suggestive of appendicitis is limited. The objectives of the study are to evaluate the efficacy of morphine before surgical consultation in children presenting to the pediatric emergency department (ED) with right lower quadrant pain suggestive of appendicitis and determine whether it has an impact on the time between arrival in the ED and the surgical decision.

Key Study: Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department

Visit

Bailey B, Bergeron S, Gravel J, Daoust R

Study Objective: In children, the agreement between the many scales used to document the intensity of pain is not well known. Thus, to determine the agreement, we evaluate the visual analog scale, the standardized color analog scale, the Wong-Baker FACES Pain Rating Scale, and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department (ED).

Key Study: A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department

Visit

Borland M, Jacobs I, King B, O'Brien D

Study Objective: We compare the efficacy of intranasal fentanyl versus intravenous morphine in a pediatric population presenting to an emergency department (ED) with acute long-bone fractures.

Key Study: A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma

Visit

Clark E, Plint AC, Correll R, Gaboury I, Passi B

Objective: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries.

Key Study: Effectiveness of oxycodone, ibuprofen, or the combination in the initial management of orthopedic injury-related pain in children

Visit

Koller DM, Myers AB, Lorenz D, Godambe SA

Objective: Orthopedic injuries comprise a majority of the indications for analgesia in the emergency department. Oxycodone and ibuprofen have demonstrated efficacy for this indication, but no studies have compared these drugs in children. Our objective was to investigate the effectiveness of oxycodone, ibuprofen, or their combination for the management of orthopedic injury-related pain in children.

Key Study: Pain assessment for pediatric patients in the emergency department

Visit

Drendel AL, Brousseau DC, Gorelick MH

Objective: To examine the relationship between pediatric patient visit characteristics and pain score documentation in the emergency department (ED) and determine whether documentation of a pain score is associated with increased analgesic use.

Key Study: Early analgesia for children with acute abdominal pain

Visit

Green R, Bulloch B, Kabani A, Hancock BJ, Tenenbein M

Objectives: The objectives of this study were to determine whether the administration of morphine to children with acute abdominal pain would impede the diagnosis of appendicitis and to determine the efficacy of morphine in relieving the pain.

Key Study: Oxycodone vs placebo in children with undifferentiated abdominal pain: a randomized, double-blind clinical trial of the effect of analgesia on diagnostic accuracy

Visit

Kokki H, Lintula H, Vanamo K, Heiskanen M, Eskelinen M

Objective: To evaluate the effects of buccal oxycodone on pain relief, physical examination findings, diagnostic accuracy, and final clinical outcomes in children with acute abdominal pain.

Key Study: Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac

Visit

Brousseau DC, Duffy SJ, Anderson AC, Linakis JG

Study Objective: We compare the effectiveness of intravenous ketorolac and intravenous prochlorperazine in the treatment of pediatric migraine headaches.

Key Study: Emergency department analgesia for fracture pain

Visit

Brown JC, Klein EJ, Lewis CW, Johnston BD, Cummings P

Study Objectives: We analyze records of all emergency department (ED) patients with extremity or clavicular fractures to describe analgesic use, compare analgesia between adults and children, and compare analgesia between the subset of these adults and children with documented moderate or severe pain. Among children, we compare treatment between pediatric and nonpediatric facilities.

Key Study: A randomized clinical trial of analgesia in children with acute abdominal pain

Visit

Kim MK, Strait RT, Sato TT, Hennes HM

Objective: To evaluate the effects of intravenous morphine on pain reduction, physical examination, and diagnostic accuracy in children with acute abdominal pain.

Key Study: The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement

Visit

Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B

The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version.

Key Study: The FLACC: a behavioral scale for scoring postoperative pain in young children

Visit

Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S

Purpose: To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability.

Key Study: Changes in Pain Score Associated With Clinically Meaningful Outcomes in Children With Acute Pain.

Visit

Tsze DS, Hirschfeld G, von Baeyer CL, Suarez LE, Dayan PS.

This was a crosssectional study of children 6 to 17 and 4 to 17 years old who were assessed using the Verbal Numerical Rating Scale (VNRS) and Faces Pain ScaleRevised (FPSR), respectively

Key Study: Comparison of the psychometric properties of 3 pain scales used in the pediatric emergency department: Visual Analogue Scale, Faces Pain Scale-Revised, and Colour Analogue Scale.

Visit

Le May S, Ballard A, Khadra C, Gouin S, Plint AC, Villeneuve E, Msse B, Tsze ...

The aim of this study was to determine and compare the psychometric properties of 3 self-reported pain scales commonly used in the pediatric emergency department (ED)

Key Study: Defining No Pain, Mild, Moderate, and Severe Pain Based on the Faces Pain Scale-Revised and Color Analog Scale in Children With Acute Pain.

Visit

Tsze DS, Hirschfeld G, Dayan PS, Bulloch B, von Baeyer CL.

The aims of this study were to define theFacesPainScaleRevised(FPS-R) andColor Analog Scale(CAS) scores associated with nopain, mildpain, moderatepain, and severepainin children with acutepain, and to identify differences based on age, sex, and ethnicity.

Key Study: A comparison of pain assessment by physicians, parents and children in an outpatient setting

Visit

Christina Brudvik,Svein-Denis Moutte, Valborg Baste,andTone Morken

Our objective was to compare pain assessments by patients, parents and physicians in children with different medical conditions, and analyse how this affected the physicians' administration of pain relief.

Key Study: Oral Analgesics Utilization for Children With Musculoskeletal Injury (OUCH Trial): An RCT

Visit

Le May S, Ali S, Plint AC, Msse B, Neto G, Auclair MC, Drendel AL, Ballard A,...

We aimed to test the efficacy of a combination of an anti-inflammatory drug with an opioid for pain management of MSK-I in children presenting to the ED.

Key Study: FactorsAssociatedWithDischargeAfterInitialEmergency TreatmentofPediatricMigraine.

Visit

Aravamuthan BR,Mar SS,Williams KG.

Migraine treatment varies widely in the pediatric emergency department (ED). Factors associated with discharge after only initial emergency treatment were examined.

Key Study: Efficacy and tolerability of zolmitriptan nasal spray for the treatment ofacutemigraine in adolescents: Results of a randomized, double-blind, multi-center, parallel-group study (TEENZ).

Visit

Winner P,Farkas V,tillov H,Woodruff B,Liss C,Lillieborg S,Raines S;TEENZ Stud...

The primary objective of the TEENZ Study (NCT01211145) was to assess the efficacy of zolmitriptan nasal spray in the acute treatment of adolescent migraine patients (ages 12 to 17 years), as measured by the primary outcome variable of pain-free status at 2 hours post-treatment.

Key Study: Drugs for the acute treatment of migraine in children and adolescents.

Visit

Richer L, Billinghurst L, Linsdell MA, Russell K, Vandermeer B, Crumley ET, D...

To assess the effects of pharmacological interventions by any route of administration versus placebo for migraine in children and adolescents 17 years of age or less. For the purposes of this review, children were defined as under 12 years of age and adolescents 12 to 17 years of age.

Key Study: Vital Signs Are Not Associated with Self-Reported Acute Pain Intensity in the Emergency Department

Visit

Daoust R, Paquet J, Bailey B, Lavigne G, Piette E, Sanogo K, Chauny JM

Objectives: This study aimed to ascertain the association between self-reported pain intensity and vital signs in both emergency department (ED) patients and a subgroup of patients with diagnosed conditions known to produce significant pain.

Key Study: Ultrasound-guided forearm nerve blocks in kids: a novel method forpaincontrol in the treatment of hand-injuredpediatricpatients in the emergency department.

Visit

Frenkel O,Liebmann O,Fischer JW.

Ultrasound-guided forearm nerve blocks have been shown to safely reduce pain for emergency procedures in the adult emergency department (ED). Although ultrasonography is widely used for forearm nerve blocks in the adult ED and in the pediatric operating room, no study to date has examined its use in the pediatric emergency setting.

Key Study: Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial

Visit

Poonai N, Bhullar G, Lin K, Papini A, Mainprize D, Howard J, Teefy J, Bale M,...

Recent warnings from Health Canada regarding codeine for children have led to increased use of nonsteroidal anti-inflammatory drugs and morphine for common injuries such as fractures. Our objective was to determine whether morphine administered orally has superior efficacy to ibuprofen in fracture-related pain.

Key Study: Association of race and ethnicity with management of abdominal pain in the emergency department

Visit

Johnson TJ, Weaver MD, Borrero S, Davis EM, Myaskovsky L, Zuckerbraun NS, Kra...

Objective: To determine if race/ethnicity-based differences exist in the management of pediatric abdominal pain in emergency departments (EDs).

Key Study: Reliability of the visual analog scale in children with acute pain in the emergency department

Visit

Bailey B, Gravel J, Daoust R

In children, many psychometric properties of the visual analogue scale (VAS) are known, including the minimum clinically significant difference (10mm on a 100-mm VAS). However, its imprecision or reliability is not well known. Thus, in order to determine the reliability of this scale, a prospective cohort study was performed in patients aged 8-17 years presenting to a pediatric emergency department with acute pain.

Key Study: Equivalency of two concentrations of fentanyl administered by the intranasal route for acute analgesia in children in a paediatric emergency department: a randomized controlled trial

Visit

Borland M, Milsom S, Esson A

Objective: Intranasal fentanyl's (INF) effectiveness is established using highly concentrated INF (HINF). Standard concentration INF (SINF) is more widely available. We aimed to illustrate the equivalence of SINF to HINF.

Key Study: Pain assessment for children: overcoming challenges and optimizing care

Visit

Drendel AL, Kelly BT, Ali S

This review will highlight the many complexities of the assessment of pain for the pediatric patient. In addition, a variety of factors that affect the self-report of pain in children will be identified.

Key Study: Pain management of musculoskeletal injuries in children: current state and future directions

Visit

Ali S, Drendel AL, Kircher J, Beno S

Objectives: Upon completion of this CME article, the reader should be better able to (1) distinguish multiple nonpharmacological techniques for minimizing and treating pain and anxiety in children with musculoskeletal injuries, (2) apply recent medical literature in deciding pharmacological strategies for the treatment of children with musculoskeletal injuries, and (3) interpret the basic principles of pharmacogenomics and how they relate to analgesic efficacy.

Key Study: Use of intranasal fentanyl for the relief of pediatric orthopedic trauma pain

Visit

Saunders M, Adelgais K, Nelson D

Objectives: The objective was to evaluate the use of a single 2 g/kg dose of intranasal fentanyl as analgesia for painful orthopedic injuries in children presenting to a pediatric emergency department (ED).

Key Study: Clinical outcomes of children treated with intravenous prochlorperazine for migraine in a pediatric emergency department

Visit

Trottier ED, Bailey B, Dauphin-Pierre S, Gravel J

Objective: To evaluate the rate of treatment failure associated with prochlorperazine used in children with severe migraine in a pediatric ED.

Key Study: A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain

Visit

Drendel AL, Gorelick MH, Weisman SJ, Lyon R, Brousseau DC, Kim MK

Study Objective: We compare the treatment of pain in children with arm fractures by ibuprofen 10 mg/kg versus acetaminophen with codeine 1 mg/kg/dose (codeine component).

Key Study: Ibuprofen provides analgesia equivalent to acetaminophen-codeine in the treatment of acute pain in children with extremity injuries: a randomized clinical trial

Visit

Friday JH, Kanegaye JT, McCaslin I, Zheng A, Harley JR

Objectives: This study compared the analgesic effectiveness of acetaminophen-codeine with that of ibuprofen for children with acute traumatic extremity pain, with the hypothesis that the two medications would demonstrate equivalent reduction in pain scores in an emergency department (ED) setting.

Key Study: Comparative review of the clinical use of intranasal fentanyl versus morphine in a paediatric emergency department

Visit

Borland ML, Clark LJ, Esson A

Objectives: Comparison of intranasal fentanyl (INF) and parenteral morphine in children in an ED. Primary objective was to compare time to analgesia from presentation, with secondary objectives to assess patient profiles, specifics of opiate analgesics used plus rate of i.v. access for analgesia alone.

Key Study: Oxycodone versus codeine for triage pain in children with suspected forearm fracture: a randomized controlled trial

Visit

Charney RL, Yan Y, Schootman M, Kennedy RM, Luhmann JD

Objective: To compare the efficacy of pain reduction of triage oxycodone (O) versus codeine (C) to children with suspected forearm fractures.

Key Study: Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial

Visit

Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A

Study Objective: The evidence supporting the use of analgesia in children with abdominal pain suggestive of appendicitis is limited. The objectives of the study are to evaluate the efficacy of morphine before surgical consultation in children presenting to the pediatric emergency department (ED) with right lower quadrant pain suggestive of appendicitis and determine whether it has an impact on the time between arrival in the ED and the surgical decision.

Key Study: Comparison of four pain scales in children with acute abdominal pain in a pediatric emergency department

Visit

Bailey B, Bergeron S, Gravel J, Daoust R

Study Objective: In children, the agreement between the many scales used to document the intensity of pain is not well known. Thus, to determine the agreement, we evaluate the visual analog scale, the standardized color analog scale, the Wong-Baker FACES Pain Rating Scale, and a verbal numeric scale in children with acute abdominal pain suggestive of appendicitis in a pediatric emergency department (ED).

Key Study: A randomized controlled trial comparing intranasal fentanyl to intravenous morphine for managing acute pain in children in the emergency department

Visit

Borland M, Jacobs I, King B, O'Brien D

Study Objective: We compare the efficacy of intranasal fentanyl versus intravenous morphine in a pediatric population presenting to an emergency department (ED) with acute long-bone fractures.

Key Study: A randomized, controlled trial of acetaminophen, ibuprofen, and codeine for acute pain relief in children with musculoskeletal trauma

Visit

Clark E, Plint AC, Correll R, Gaboury I, Passi B

Objective: Our goal was to determine which of 3 analgesics, acetaminophen, ibuprofen, or codeine, given as a single dose, provides the most efficacious analgesia for children presenting to the emergency department with pain from acute musculoskeletal injuries.

Key Study: Effectiveness of oxycodone, ibuprofen, or the combination in the initial management of orthopedic injury-related pain in children

Visit

Koller DM, Myers AB, Lorenz D, Godambe SA

Objective: Orthopedic injuries comprise a majority of the indications for analgesia in the emergency department. Oxycodone and ibuprofen have demonstrated efficacy for this indication, but no studies have compared these drugs in children. Our objective was to investigate the effectiveness of oxycodone, ibuprofen, or their combination for the management of orthopedic injury-related pain in children.

Key Study: Pain assessment for pediatric patients in the emergency department

Visit

Drendel AL, Brousseau DC, Gorelick MH

Objective: To examine the relationship between pediatric patient visit characteristics and pain score documentation in the emergency department (ED) and determine whether documentation of a pain score is associated with increased analgesic use.

Key Study: Early analgesia for children with acute abdominal pain

Visit

Green R, Bulloch B, Kabani A, Hancock BJ, Tenenbein M

Objectives: The objectives of this study were to determine whether the administration of morphine to children with acute abdominal pain would impede the diagnosis of appendicitis and to determine the efficacy of morphine in relieving the pain.

Key Study: Oxycodone vs placebo in children with undifferentiated abdominal pain: a randomized, double-blind clinical trial of the effect of analgesia on diagnostic accuracy

Visit

Kokki H, Lintula H, Vanamo K, Heiskanen M, Eskelinen M

Objective: To evaluate the effects of buccal oxycodone on pain relief, physical examination findings, diagnostic accuracy, and final clinical outcomes in children with acute abdominal pain.

Key Study: Treatment of pediatric migraine headaches: a randomized, double-blind trial of prochlorperazine versus ketorolac

Visit

Brousseau DC, Duffy SJ, Anderson AC, Linakis JG

Study Objective: We compare the effectiveness of intravenous ketorolac and intravenous prochlorperazine in the treatment of pediatric migraine headaches.

Key Study: Emergency department analgesia for fracture pain

Visit

Brown JC, Klein EJ, Lewis CW, Johnston BD, Cummings P

Study Objectives: We analyze records of all emergency department (ED) patients with extremity or clavicular fractures to describe analgesic use, compare analgesia between adults and children, and compare analgesia between the subset of these adults and children with documented moderate or severe pain. Among children, we compare treatment between pediatric and nonpediatric facilities.

Key Study: A randomized clinical trial of analgesia in children with acute abdominal pain

Visit

Kim MK, Strait RT, Sato TT, Hennes HM

Objective: To evaluate the effects of intravenous morphine on pain reduction, physical examination, and diagnostic accuracy in children with acute abdominal pain.

Key Study: The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement

Visit

Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, Goodenough B

The Faces Pain Scale (FPS; Bieri et al., Pain 41 (1990) 139) is a self-report measure used to assess the intensity of children's pain. Three studies were carried out to revise the original scale and validate the adapted version.

Key Study: The FLACC: a behavioral scale for scoring postoperative pain in young children

Visit

Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S

Purpose: To evaluate the reliability and validity of the FLACC Pain Assessment Tool which incorporates five categories of pain behaviors: facial expression; leg movement; activity; cry; and consolability.